Serial elongation derotation flexion casting in children with infantile and juvenile scoliosis

Abstract

Infantile (IS) and juvenile scoliosis (JS) are among the most challenging conditions pediatric orthopedic surgeons are facing in the present days. However, the best treatment of IS and JS is still debated and it remains controversial, at least for some aspects. Untreated early onset spinal deformities may lead to pulmonary and heart compromise. Growth friendly surgical techniques imply multiple distractions with increased risk of auto-fusion, infection and curve stiffening. Serial casting has been proven to be a valuable option to treat children with early onset scoliosis (EOS) in an attempt to delay surgery (in most cases) or to cure the disease (in few cases). More than five decades ago, Cotrel and Morel from France, introduced the Elongation-Derotation-Flexion (EDF) casting technique. EDF cast is a custom-made thoracolumbar cast that corrects the deformed spine three-dimensionally. Serial EDF casting is able to modulate spinal growth and it can-at least in some cases-prevent the progression of the spinal deformity. Today, serial EDF casting technique has become one of the accepted treatment options for the management of children with IS and JS.The main objective of this work is to describe the EDF serial casting technique for the treatment of children with IS and JS, as well as to highlight its advantages and its limits by providing a review of the most recent literature.

Clinical Results of Corrective Cast and Brace Treatment for Early-onset Scoliosis: The Effectiveness of Long-term Cast Treatment That Extends into Children’s Schooldays

“…Although cast application for older patients with larger curves or a nonidiopathic etiology still results in curve improvement, it is also a valuable option to delay surgical treatment, even in patients with a nonidiopathic etiology. 7,8,[12][13][14][15][16][17][18][19] Moreover, this treatment is considered safe because few complications occur in spite of the decreased chest wall compliance and restricted pulmonary function, [18][19][20][21][22] and delaying surgery helps to decrease numerous complications of growth-friendly procedures. 12,23 Although various types of cast treatment cannot achieve better curve correction than growing rod surgery, the results of cast application are generally satisfactory and may serve as one treatment option for EOS.…”

“…Cast treatment can reportedly resolve infantile scoliosis if performed in the early stage of progression, and good indications for cast application include smaller, more flexible curves and IS. Although cast application for older patients with larger curves or a nonidiopathic etiology still results in curve improvement, it is also a valuable option to delay surgical treatment, even in patients with a nonidiopathic etiology 7,8,12–19. Moreover, this treatment is considered safe because few complications occur in spite of the decreased chest wall compliance and restricted pulmonary function,18–22 and delaying surgery helps to decrease numerous complications of growth-friendly procedures 12,23.…”

“…[9][10][11] A serial EDF cast can reportedly modulate spinal growth, cure scoliosis in a few cases, and delay surgery in most cases if worn for 2 to 3 months with allowance for summer holidays. 7,8,[12][13][14] ARCBT can also significantly slow scoliosis progression if the cast is worn for a shorter term (2 to 3 weeks), a well-fitted brace is worn for several months, and repetitive casting is performed when the scoliosis progresses. However, the effectiveness of ARCBT is unknown after the age of 7 years, at which time patients discontinue the repetitive cast treatment because they begin attending school.…”

“…Serial EDF casts seem to be favored in western countries, whereas alternatively repetitive cast and brace treatment (ARCBT) seems to be favored in Japan 9–11. A serial EDF cast can reportedly modulate spinal growth, cure scoliosis in a few cases, and delay surgery in most cases if worn for 2 to 3 months with allowance for summer holidays 7,8,12–14. ARCBT can also significantly slow scoliosis progression if the cast is worn for a shorter term (2 to 3 weeks), a well-fitted brace is worn for several months, and repetitive casting is performed when the scoliosis progresses.…”

Efficacy and Safety of Systemic and Locoregional Cisplatin Chronotherapy in Rats with Ovarian Carcinoma

“… 21 , 22 HIPEC is being studied as a therapeutic option for patients with locally advanced and locally recurrent ovarian cancer with few remaining therapeutic options, and it has shown efficacy in combination with cytoreductive surgery. 23 …”